Shanker Pasupathy

Singapore General Hospital | SGH · Department of Surgery

Background: Weight loss, early after Roux-en-Y gastric bypass (GB) surgery, is associated with reduced concentrations of plasma branched-chain amino acids (BCAAs) and improved insulin sensitivity. Herein, we evaluated whether changes in BCAAs and insulin sensitivity persist with weight stabilization (1 year) after GB or sleeve gastrectomy (SG). M...

Bone loss after bariatric surgery is well recognized but the best method for quantifying bone mineral density (BMD) remains controversial. BMD measured with dual energy X-ray absorptiometry (DXA) is prone to measurement errors in this population while quantitative computed tomography (QCT) is less affected. We report the skeletal changes after bari...

The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Obesity to provide health professionals in Singapore with recommendations for evidence-based interventions for obesity. This article summarises the introduction, epidemiology and executive summary of the key recommendations from the HPB-MOH CPG on Obesity for t...

To compare the efficacy and safety of cutting balloon angioplasty (CBA) versus high-pressure balloon angioplasty (HPBA) for the treatment of hemodialysis autogenous fistula stenoses resistant to conventional percutaneous transluminal angioplasty (PTA). In a prospective, randomized clinical trial involving patients with dysfunctional, stenotic hemod...

Obesity-associated severe asthma is a distinct phenotype characterised by resistance to standard asthma therapies. Bariatric surgery appears to be a viable alternative for those who have failed trials of traditional weight loss methods. However, anaesthetic and surgical risks are potential barriers. We describe three patients with treatment-resista...

Introduction: Obesity is a risk factor for type 2 diabetes mellitus (T2DM). Metabolic-bariatric surgery (MBS) results in significant weight loss with dramatic improvement in T2DM. This study analysed the effects of MBS on patients with T2DM in a tertiary centre in Singapore. Methods: Individuals with T2DM who underwent MBS in a single centre fro...

Purpose To determine the efficacy of drug eluting balloon angioplasty (DEB) in reducing late luminal loss, improving restenosis rates, and prolonging patency rates of arteriovenous fistula and graft compared to conventional percutaneous balloon angioplasty (PTA) at 6 months. Materials and Methods From January to March 2012, 30 patients (15 males)...

A review of the management of vessel rupture after angioplasty of malfunctioning hemodialysis access in a single tertiary institution.Materials and MethodsA retrospective database of endovascular treatment for malfunctioning hemodialysis arteriovenous fistulas (AVF) and grafts (AVG) between January 2007 and August 2012 was obtained. 52 vessel ruptu...

Obesity is a major public health concern worldwide, including Singapore. Bariatric surgery has grown in popularity to combat this situation, and innovations in this field have led to the emergence of new bariatric procedures. For the healthy growth of this specialized field of surgery, it is mandatory to audit the progress and state of bariatric su...

SESSION TYPE: Surgery Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Bariatric surgery is an increasingly common procedure to treat obesity. A rare complication of laparoscopic sleeve gastrectomy is gastrobronchial fistulation.CASE PRESENTATION: A 30-year-old woman presented with a productive cough fo...

ABStrAct After the end of the second world war, the world saw a significant period of growth and prosperity unlike any previously. By the 1950s, morbid obesity was proving to be a clinical problem in many developed societies in Europe and North America. Diet, lifestyle and medication alone did not appear to be effective in controlling morbid obesit...

Obesity is a major public health concern around the world, including Asia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for...

The splenic artery arising from the superior mesenteric artery is an uncommon anatomical variant. This aberrant origin may rarely be associated with an aneurysm. Previous cases have been managed with surgery and combined surgical/endovascular or endovascular techniques, with the latter involving occlusion of the aneurysm with coils. We report a cas...

Morbid obesity is associated with increased morbidity and mortality. Bariatric surgery offers morbidly obese individuals substantial and sustainable weight loss and reduction in obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) is a new restrictive procedure in bariatric surgery. We aimed to evaluate our experience with LSG with...

To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients. A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective...

This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA). 573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA...

To describe the defining characteristics and treatment of necrotizing fasciitis (NF), emphasizing early diagnostic indications. PubMed was searched using the terms necrotizing fasciitis and necrotizing soft tissue infections, paired with early diagnosis. Results were limited to human studies in English. Additional articles were obtained from refere...

Although transgastric intraperitoneal surgery is feasible both in experimental models and humans, secure gastrotomy closure remains challenging. As there is still no method that is simple, reliable, inexpensive, and effective, we aimed to evaluate the feasibility, efficacy, and safety of a novel endoscopic approach to this issue that intends to ens...

The initial idea behind natural orifice transluminal endoscopic surgery (NOTES) was that of an incisionless surgery. NOTES cholecystectomy is a good model of human ingenuity and technological advance. NOTES cholecystectomy in a human being was performed at our institution after extensive laboratory work in live pig models. In this process we gained...

Natural orifice transluminal endoscopic surgery (NOTES) is the latest minimally invasive technique in the surgical armamentarium. Indeed it is stoking controversy already among both practitioners and patients, challenging established surgical, ethical and even moral principles. One organ which has been at the forefront of minimally invasive interve...

The expression and potential role of platelet membrane CD154 and sCD154 in atherosclerosis was investigated in patients with peripheral arterial disease. This prospective observational study measured the expression of platelet-bound CD154 and soluble CD154 (sCD154) in 39 patients with critical limb ischaemia (CLI, n=15), stable intermittent claudic...

Ischemic preconditioning (IP) has emerged as a powerful experimental method of ameliorating ischemic injury in a variety of organs. This systematic review examines the surgical implications of this phenomenon. Data Source A MEDLINE search was conducted to identify laboratory and clinical studies investigating IP-induced protection in a variety of o...

A major challenge for gene therapy is to be able to deliver efficiently the gene of interest to specific cell types. Here we describe a safe and simple effective naked DNA gene delivery method, via inferior vena cava (IVC) injection, to the recipient's kidneys. It was further demonstrated that gene expression was concentrated in the proximal tubula...

Ischaemic preconditioning (IP) has emerged as a powerful method of ameliorating ischaemia/reperfusion (I/R) injury to the myocardium. This review investigates whether this phenomenon is universally applicable in modulating I/R injury to other tissues. A Medline search was conducted to identify both animal and human studies that described IP-induced...

The effects of exercise and warm-up were investigated in patients with claudication. This case-control crossover study involved two treadmill exercise tests, one preceded by a warm-up. Exercise continued until maximal leg pain (patients with claudication) or exhaustion (controls). Blood was taken before, and 5 and 60 min after exercise for flow cyt...

We present a case of acute embolus to the superior mesenteric artery (SMA). A 70-year-old gentleman with atrial fibrillation complained of colicky abdominal pain with clinical signs of tenderness and mild guarding. Laparotomy revealed extensive bowel ischaemia but no overt infarction. The SMA was occluded by an embolus at the root of the mesentery...

Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. The present report describes the clinical presentation and microbiological characteristics of this condition as well as the determinants of mortality associated with this uncommon surgical emergency. The medical records of eighty-nine conse...

The aim of this prospective study was to compare the surgical outcomes in patients undergoing laparoscopic assisted vs. open ultralow anterior resection (ULAR) with the creation of a colonic pouch-anal anastomosis. Patients undergoing ULAR with creation of a colonic pouch and who either had conventional open (CO) or laparoscopic assisted (LA) surge...

The aim of this prospective study was to compare the surgical outcomes in patients undergoing laparoscopic assisted vs. open ultralow anterior resection (ULAR) with the creation of a colonic pouch-anal anastomosis. Patients undergoing ULAR with creation of a colonic pouch and who either had conventional open (CO) or laparoscopic assisted (LA) surge...